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If your Medicare Advantage plan is ending in 2027, it could mean different doctors, interrupted care and unexpected bills.
Here’s how to find out if these changes will impact you.
A surprise $20,000 bill for a Medicare beneficiary
More than 3 million Medicare beneficiaries will lose their Medicare Advantage plans as of Jan.1, 2027. Getting the health care they need could get more complicated and more expensive unless they do something soon.
Take the case of an 83-year-old woman I met in my role as a Medicare counselor in the SHIP program. I’m calling her Mrs. X to protect her identity and health information.
Mrs. X. had been in Medicare Advantage (MA) plans for 18 years, seeing the same primary care doctor all that time and the same specialists consistently. Then one day, she showed up for a scheduled CT scan. Employees told her they could not complete the scan because she had no coverage for the procedure. They told her the doctor who had ordered the scan was not in her plan’s network and neither was the imaging facility she had been using.
She was told to contact a different medical group and to make an appointment with a primary care physician whom she has never seen nor heard of. That was followed by a bill for nearly $20,000 for out-of-network, and therefore unpaid, medical services from January thru March.
The unread Annual Notice of Change
It turns out her MA plan had terminated at midnight the prior Dec. 31. For whatever reason, she did not read or understand or act on the Annual Notice of Change (ANOC) that her MA plan sent her. That notice clearly stated that her plan would be ending and, if she did nothing, she would be moved (the term Medicare and the insurance companies use is “crosswalked”) to a different MA plan offered by that same insurance company.
She was crosswalked to a plan that did not contract with her long-time providers. In fairness to Mrs. X, the ANOC did not specifically say whether the substitute plan would contract with her providers (and that was a factor in the resolution of the case, which I will explain later).
What is important to understand is that if she had read the notice and asked a few questions, she could have avoided the interruption in her care and the headaches and anxiety that come with big unpaid medical bills.
Related: Why does my Medicare Advantage plan keep asking me for a home visit?
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Medicare Advantage plans are dumping members
We are now in Medicare’s Annual Election Period (AEP), also called Open Enrollment. It runs from Oct. 15 through Dec. 7.
As of Sept. 30, about 3.2 million people in MA plans received ANOCs telling them their plan is terminating. I’m using the number cited by CNN and other sources, although I’ve seen one estimate saying almost five million are affected.
Nationally, many of the insurance companies that own and run the MA plans are deliberately trying to reduce enrollment. They’re doing it by shrinking their coverage areas and eliminating MA plans in hundreds of counties.
The hardest-hit state is Minnesota. About 63% of the MA enrollees in that state are affected by plan terminations according to an analysis by research firm Medicare Market Insights. One particular county there has about 67,000 impacted enrollees.
It’s all about profitability and Wall Street expectations. In various forms, the companies have said they intend to focus on profit margins over members. They’re doing so by reducing the number of regular MA plans they offer. At the same time, they’re increasing the number of Special Needs Plans. These are MA plans that typically target those with special medical conditions, such as heart disease or diabetes. The companies can potentially get significantly more money from Medicare for people in Special Needs Plans.
If you or someone you care about is in a Medicare Advantage plan that’s ending, act before Dec. 7
- If you want to stay with MA, you can switch to a different MA plan. However, you may have to change doctors and/or other providers. If you want to keep your current doctor, call their billing office and ask if they contract with the new plan you’re considering. If not, which plans do they contract with? Do the same with hospitals if access to a particular hospital is important to you.
If the ANOC tells you it is crosswalking you to another MA plan, ask the same questions. Otherwise, you might face the same problems as Mrs. X. - You can switch from MA to Original Medicare. Most people who have been in MA for more than a year are subject to underwriting if they try to get a Medicare Supplement (Medigap) plan. That means the insurance companies that sell those plans can ask you about any and all preexisting conditions and can deny you based on your medical history. Not having a Medigap plan would leave you facing unpredictable and unlimited out-of-pocket costs. KFF reported this month that nearly three-quarters of MA members could be denied a Medigap policy because of a preexisting condition.
However, if your MA plan terminates, Medicare rules give you a special opportunity, called a “Guaranteed Issue Right,” to pick up a Medigap plan without regard to your preexisting conditions. Under those circumstances, Medigap plans cannot deny you or charge you a higher premium because of your medical history.
- But there are time limits on when you can take advantage of that opportunity. You can enroll up to 60 days before your plan ends, with coverage effective Jan. 1. You also can enroll up to 63 days after the plan ends, which (in non-leap years) would be March 4 (a few states give you a little more time). Medigap coverage would begin the month after you enroll.
If you decide to move to Original Medicare, you will also need to add a prescription drug plan. The timing is tighter if your MA plan includes drug coverage. That’s because Medicare rules subject you to a late enrollment penalty if you go more than 63 days without a drug plan or other creditable coverage.
When you enroll in a drug plan, coverage begins the first of the following month. So you would have to enroll in your new drug plan by Feb. 28. If you wait until March 1, your coverage will start in April along with your late enrollment penalty. - You do have one more option if your MA plan terminates: You can do nothing. In that case, you will be automatically switched to Original Medicare. But then you’ll still have to get a Medigap and a drug plan. So see option #2 above.
Related: Here is why some Medicare Advantage members feel trapped
Even if your MA plan is not ending, it’s still in your best interest to review the ANOC to see what is changing. Plans will be increasing premiums, increasing copays, reducing or eliminating certain benefits, terminating contracts with providers or hospitals, or some combination of these actions. Many will be increasing the maximum out-of-pocket amount they can charge in copays for in-network services to the new federal limit of $9,850 (not counting premiums).
In the county where I live, ten plans are terminating at the end of this year. All but one of the remaining MA plans will increase costs and/or reduce benefits for 2027.
The State Health Insurance Assistance Program (SHIP) steps in
It was April of the new plan year by the time I saw Mrs. X. By then, she had filed appeals and a grievance that were denied.
What she did not know was that the insurance company had created a new MA plan with her long-time providers in-network. But that new plan contract was not finalized until after the AEP.
Medicare has a separate Medicare Advantage Open Enrollment Period during the first quarter of each year. Mrs. X could have used that second period to switch MA plans and regain access to her providers. But she wasn’t notified of the new plan’s existence.
Our efforts to mediate the issue with the insurance company went nowhere. The next step was a formal written complaint to the Centers for Medicare and Medicaid Services (CMS). Working with our local program director, I drafted a complaint asking that CMS require the insurance company to retroactively enroll Mrs. X in their newly-created plan. We argued that the company did not properly inform her of the network changes that would result from crosswalking. Nor did it inform her of the option of enrolling in the new plan that covered her providers.
A happy result for Mrs. X
CMS agreed. The company enrolled her in the new plan and made it retroactive to Jan. 1. That meant all of her services were in-network and costs were covered after all. The following AEP her new MA plan terminated. But this time she paid attention. She met with me in time to help her switch to Original Medicare and use the Guaranteed Issue right to get a Medigap plan.
A win in a case for someone like Mrs. X feels good. But I also know (fear?) that in 2027 too many others will find themselves trying to untangle a mess that began with ignoring an ANOC.
Don’t be one of them.
Do You Have a Medicare Question?
If you have a Medicare question, feel free to contact me at Ask Abe here at Consumer Rescue. I’m a registered SHIP Medicare counselor with ten years of experience helping beneficiaries.
